Transcription of Medical Services Plan (MSP) - British Columbia
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Medical Services Plan (MSP) - British Columbia
Medical Services PLAN (MSP)APPLICATION FOR ENROLMENTBIRTHDATE (MM / DD/ YYYY) GENDER DAYTIME TELEPHONE NUMBER M FRESIDENTIAL ADDRESS CITY PROV POSTAL CODEMAILING ADDRESS (IF DIFFERENT FROM RESIDENTIAL ADDRESS) CITY PROV POSTAL CODESTATUS IN CANADA - PROVIDE PHOTOCOPIES OF ALL APPLICABLE DOCUMENTS (DO NOT SEND ORIGINALS) CANADIAN CITIZEN Canadian Birth Certificate, HOLDER OF PERMANENT RESIDENT STATUS Record of Landing, Permanent OTHER Work or Study Permit, etc. Canadian Citizenship Card or Passport Resident Card (front & back) or Confirmation of Permanent Residence WILL YOU OR ANY FAMILY MEMBER BE AWAY FROM BC FOR MORE THAN 30 DAYS IN TOTAL IN THE NEXT SIX MONTHS? IF YES, SEE RESIDENCY, PAGE YOU A FULL-TIME STUDENT?IF YES, WILL YOU RESIDE IN BC ON COMPLETION OF YOUR STUDIES? IF ANYONE LISTED IS AN ACTIVE MEMBER OF, OR HAS BEEN RELEASED FROM, THE CANADIAN FORCES, RCMP OR AN INSTITUTION, PLEASE PROVIDE THE DISCHARGE DATE:(MM / DD / YYYY)This form may also be completed and submitted online at complete MSP enrolment, adult Canadian Citizens and Permanent Residents must obtain a Photo BC Services Card by visiting an Insurance Corporation of BC (ICBC) driver licensing office.
or children who reside in BC, they also must meet these requirements. Please see the Application for Enrolment for the definition of resident. Absences from BC: You must indicate if you have been absent from BC for more than 30 days in total during the past 12 months. (See Section 2D on the Application for Enrolment).
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